Medicare Compliance & Reimbursement

CCI 13.1 will delete troublesome stereotactic edits.

Radiation therapy providers have been struggling since January with a set of Correct Coding Initiative (CCI) edits. Now, as of April 1, those edits will be deleted retroactive to January.

CCI version 13.1 deletes edits bundling stereotactic treatment management codes with stereotactic treatment codes, according to the American College of Radiation Oncology. You'll be able to bill 77432 on the same date as 77371-77372, and 77435 on the same date as 77373.

These edits have been a "big problem," says Cindy Parman, a principal and co-founder of Coding Strategies in Atlanta. This edit didn't affect hospitals, because they don't bill professional services, but it's been a problem for freestanding centers.

Good news: Because these edits will be deleted retroactively, you can resubmit any claims that have been denied since January. "It would be great if the Medicare contractors would automatically reprocess any denials, but practices need to be ready to resubmit for correct payment," says Parman.

Because stereotactic radiosurgery "is normally conducted in a single-fraction scenario," you would typically bill physician management in the same session as the treatment, says Deborah Churchill, president of Churchill Consulting in Killingworth, CT. So that set of CCI edits was "an error," she says.

New edit: CCI version 13.1 may also add one new edit, bundling radiation therapy management code 77431 with stereoscopic X-ray guidance code 77421. You would be able to use a modifier to override this edit.

But this edit may not take effect because the American Society for Therapeutic Radiation Oncology (ASTRO) objected. A physician may sometimes treat a patient with non-stereotactic hypofractionated radiotherapy using one or two fractions (77431), and the target may be located near "critical structures." The doctor may need to use stereoscopic X-ray guidance (77421) to "localize the target" before delivering this treatment, which has a large dose per fraction, ASTRO said.

Also, radiation therapy treatment codes such as 77431 don't include the work of real-time image guidance, ASTRO pointed out in a Nov. 22, 2006 letter to Correct Coding Solutions about this proposed edit.